On April 25 a 7.8-magnitude earthquake pounded Nepal, leaving 9,000 dead, 23,000 injured, and hundreds of thousands homeless. Less than a month later, on May 12, an aftershock hit Dolakha in central Nepal and destroyed most of the district’s health care system. For help in rebuilding that district’s clinics, the Nepali government turned to an organization founded by Yale medical students in 2005.
Possible, originally named Nyaya Health, was the brainchild of a group of Yale students who wanted to bring health care to the poor in Nepal’s western lowlands. (For those who can’t afford private doctors, Nepal has a public health care system that is often inadequate, particularly in remote rural areas.) By 2008 the students had turned a grain shed into a clinic in Accham, a district with a high rate of HIV/AIDS. Nyaya, as it was then known, was the first non-governmental organization (NGO) to receive a government contract to provide direct medical services in Nepal. After opening the clinic, the NGO began running Accham’s public Bayalpata Hospital. Nyaya changed its name to Possible in 2014. [See “A 21st Century NGO,” Yale Medicine, Winter 2012]
Possible provides care in Accham through a partnership that includes funding from the government and philanthropy. Through a pay-for-performance contract with the Nepali Ministry of Health and Population, Possible now runs a part of the Accham district’s public health system‒including care at the district-level hospital and over a dozen clinics‒caring for more than 250,000 people and striving to keep costs below $20 per patient. While their U.S.-based team oversees fundraising, more than 90 percent of the health workers in Accham are locals, and all are Nepali. “Our goal is to refine a better model for rural health care that will improve outcomes at a cost that the ministry can ultimately afford themselves,” said Ryan Schwarz, MD ’11, MBA ’11, Possible’s chief operations officer and a fellow at Brigham and Women’s Hospital in Boston.
When the earthquake struck in April, Possible was working only in Accham, but planning to expand to other districts. And Dolakha was in particular need. Even before the earthquake, according to Possible, 40 percent of the district’s 186,000 residents had no access to medical care. Because of their track record in Accham, Possible was a natural fit to help in the rebuilding effort, said Schwarz. In July, they received a contract to redevelop the devastated health care infrastructure of Dolakha.
By the end of 2015, Possible plans to rebuild or repair 21 health clinics in Dolakha, with local labor and funding from the government and from private philanthropies. In 2016, they plan to build additional clinics using earthquake-resistant techniques and solar power, and launch a sustainable, permanent health care network in the area, much as they did in Accham. This includes management, staffing, and direct medical care in facilities throughout Dolakha. The new network will include electronic medical records and a cadre of community health workers.
With the district health care system devastated by the earthquake, Possible sees an opportunity to rebuild the public health care system in Dolakha from the ground up. “Our goal is to create a health care model that will work for everybody in Nepal, not just the middle or the upper class,” said Schwarz. “Working in the poorest, most marginalized area holds us accountable, to make sure we are creating a model of care that will truly work for everybody.”